Name: AutoCart™ Procedure for an Articular Cartilage Lesion of the Condoyle
Uploaded: 2020-06-09T00:00:00Z
Channel: Arthrex
Description: Brian J. Cole, MD, MBA (Chicago, IL), discusses how he treated an articular cartilage lesion in the knee using the AutoCart™ technique. This surgical approach is a single-stage, matrix-augmented, articular cartilage graft that combines articular cartilage collected using the GraftNet™ device with BioCartilage® extracellular matrix.

<p>Brian J. Cole, MD, MBA (Chicago, IL), discusses how he treated an articular cartilage lesion in the knee using the AutoCart™ technique. This surgical approach is a single-stage, matrix-augmented, articular cartilage graft that combines articular cartilage collected using the GraftNet™ device with BioCartilage® extracellular matrix.</p>

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VID1-000688-en-US | B | AutoCart™ Procedure for an Articular Cartilage Lesion of the Condoyle

Brian J. Cole

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Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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AutoCart™ Procedure for an Articular Cartilage Lesion of the Condoyle

Hello, I'm Doctor Brian Cole from Rush University Medical Center in Chicago, and I'm going to present to you a 27 year old male with persistent knee pain and swelling, who is going to be treated with a new technique called the AutoCart autologous cartilage implantation. This is a 27 year old male with persistent lateral side and right knee pain. He has a rather complex history in that in 2016, he underwent an ACL reconstruction and a meniscectomy following a work related injury. He did very well after that surgery, and in 2018 he had a re-injury while stepping over a box. He complained of persistent knee pain and swelling and had limitations in activities of daily living. He failed physical therapy, cortisone injections and hyaluronic acid. He has already had a debridement of a tibial plateau lesion and a revision lateral meniscectomy with no relief. His physical examination demonstrates that he is in neutral alignment. His range of motion is from 0 to 135 degrees. He has tenderness along the lateral joint line. He is ligamentous stable and he is neurovascular intact. His x rays demonstrate no significant joint space narrowing and neutral alignment. His MRI demonstrates a lateral tibial plateau lesion, which is actually rather unique. It's one of the more rare locations for articular cartilage lesions, and you can see a bit of subchondral bone edema and change. You can also appreciate that he's had a partial central lateral meniscectomy at the time of arthroscopy. He had a relatively localized area of articular cartilage loss and fibrocartilage fill in an area of about 18mm by 18mm of the lateral tibial plateau. One can also appreciate that he's been partially lateral meniscectomy. The plan for this patient is to treat him with AutoCart using autologous articular cartilage, as well as BioCartilage and autologous serum for the tibial plateau lesion. The defect is prepared arthroscopically by creating vertical margins, eliminating all the defective and degenerated cartilage, and violating the calcified layer. A PowerPick is then used to create perforations within the subchondral plate to obtain access to endogenous MSCs. All of All the debris is subsequently removed from the knee. Arthroscopically. Next, we harvest autologous cartilage using the GraftNet device. This is a device that essentially has a filter that is placed in line with the suction. In this case, we use a 5.5 bone cutter on oscillate to harvest autologous cartilage from non-weight bearing zones, such as the lateral aspect of the intercondylar notch, similar to where a notch plasty is performed, or even obtaining cartilage from the edge of the trochlea laterally or medially. You can see that the filter will capture an abundance of articular cartilage that has been minimally traumatized into. Early basic science suggests that the cells remain viable. Using live dead cell assays here, you can see when the filter is opened that there's an abundance of cartilage at the base of the insertion device. Next, we proceed with preparation of autologous serum using peripheral venous blood as well as ACP. Next, we attempt to perform dry arthroscopy by eliminating any excess fluid around the lesion after the autologous serum is prepared. We basically combine one third of BioCartilage, one third of autologous cartilage obtained with the GraftNet device, and one third of autologous serum into a mixture that is subsequently introduced into the knee using the cannulas. The objective arthroscopically is to drain the area of all excess fluid to create a dry as fluid as possible. Once we introduce the AutoCart mixture, we then place the autologous serum arthroscopically over the area of repair. Here you can see introduction of the autologous serum on top of the AutoCart mixture. Postoperative radiographs demonstrate no change in joint space. Post-operative rehabilitation includes a period of non-weight bearing and utilization of CPM for approximately 6 to 8 weeks. No brace is generally necessary beyond the first two weeks. We allow gradual return to activities, including impact loading at 6 to 8 months, depending upon the clinical response of the patient. Thank you.

AutoCart™ Procedure for an Articular Cartilage Lesion of the Condoyle

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